As is known, the term “hiatal hernia” is used to define a dislocation of an abdominal viscus of the thorax through an aperture in the diaphragm called the hiatoesophageal orifice, normally traversed by the esophagus.
Through this aperture in the diaphragm the esophagus can abnormally reascend the thorax, determining a sliding (rotational) hernia along with a portion (generally the most proximal portion) of the stomach (cardia).
The sliding hernia is generally associated with a reflux pathology, that is esophagitis.
When the border between esophagus and stomach shifts within the territory of the thorax, where the pressures are opposite the abdominal pressures (during inspiration, in the thorax there are negative values and positive ones in the abdomen), the acid content of the stomach lingers a little too long in the last tract of the esophagus and tries to digest the mucosa.
Eleven percent of the population experiences symptomatic gastroesophageal reflux on a daily basis.
When gastroesophageal reflux is symptomatic, a pathological entity is always present as a consequence of the reflux, for example esophagitis.
Recent studies suggest that the increase of esophageal cancer in industrial society may be linked precisely to the columnar transformation of the distal esophageal mucosa as a consequence of chronic reflux.
To avoid at least somewhat the drawbacks complained of above, medical reflux therapy based on pro-kinetic and antacid agents is applied.
However, when the aforesaid therapy also fails, surgical intervention is provided, resulting in such anatomical changes as to allow the possible hiatal hernia to be corrected and the anti-reflux mechanism to be improved.
Nevertheless, the great disadvantage of surgical intervention is that it frequently leads to complications and disorders that are sometimes difficult for the patient to tolerate.